Citation Nr: 21040921 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 05-35 233 DATE: July 7, 2021 ORDER Service connection for a skin disability is denied. FINDING OF FACT The preponderance of the evidence is against finding that a skin disability began during the Veteran's service or is otherwise related or attributable to his service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for a skin disability. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active miliary service from June 1962 to August 1966, from June 1967 to June 1970, and from October 1970 to October 1973. The appellant is his surviving spouse, so widow. Service connection for a skin disability is denied. The basis of this claim is that the Veteran's skin disability was the result of his service in Vietnam. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or an injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In addition, a veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during that service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). For veterans presumed to have been exposed to herbicides, certain enumerated diseases shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne shall have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent. 38 C.F.R. § 3.307(a)(6)(ii). Here, though, while the Board concedes the Veteran had a diagnosed skin disorder, it was not the type of disease (namely, chloracne or other acneform disease with chloracne) contemplated by 38 U.S.C. § 1116 and 38 C.F.R. §§ 3.307(a) and 3.309(e) as presumptively associated with his presumed exposure to Agent Orange in Vietnam. Moreover, the preponderance of the evidence weighs against finding that the Veteran's skin disorder began during his service or is otherwise related or attributable to an in-service injury, event, or disease so including to his presumed exposure to Agent Orange to, in turn, establish the required correlation ("nexus") between his skin disorder and service alternatively by showing direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). See also McCartt v. West, 12 Vet. App. 164, 167 (1999) (indicating the principles set forth in Combee, which, instead, concerned exposure to radiation, are equally applicable in cases involving Agent Orange exposure to establish direct causation when the Veteran does not have one of the diseases that is presumptively associated with said exposure). First, while the Veteran reported that he had jungle rot in service, he did not provide any other statements describing his symptoms in service, duration of them, and whether they continued following his separation from service to establish continuity of symptomatology as contemplated by 38 C.F.R. § 3.303(b). See also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In this regard, the service treatment records (STRs), including the report of the Veteran's military separation examination in 1973, are grossly unremarkable for complaints of a skin rash or other symptoms referable to his skin or a skin disorder. Moreover, there is no indication he was diagnosed with chloracne or other acneform disease consistent with chloracne within one year following exposure to herbicide agents in service. Therefore, there is no showing of a chronic disability in service or indication of presumptive disease. Next, post-service treatment records also do not document reports of or treatment for a skin rash until 2003. At that time, the Veteran reported that he had been experiencing symptoms of itching of the face, right hand, ears, and groin for about 15-20 years. During his May 2018 VA examination, he again reported the onset of these symptoms was in about 1980. So, while these records recount a long history of skin rash, they still do not tend to place the onset of the rash during his service, which ended in 1973, or within one year of last exposure to Agent Orange during his service. Consider also that the May 2018 VA examiner did a physical examination of the Veteran and reviewed the evidence of record. The examiner determined that it was less likely than not the Veteran's skin disorder was etiologically related to his service. The examiner diagnosed the Veteran's skin disorder as seborrheic dermatitis and explained that this condition was extremely common in patients the Veteran's age, whether they were in service or exposed to herbicides or not. The same was the case with the Veteran's other skin finding, diagnosed as benign nevi. In September 2019, another VA examination was obtained to consider the Veteran's lay statements of symptom onset. But even this additional examiner determined that the Veteran's skin disorder was less likely than not related to his service. This additional examiner noted there was no evidence of skin symptoms in service, including on separation examination in 1973. This examiner found no indication of treatment for a rash following service separation and into the 1980s. This examiner also found no indication of a diagnosis of jungle rot, also called tinea pedis, in the existing record. This examiner agreed with the prior finding in May 2018 that the Veteran's skin disorder, seborrheic dermatitis, was common in adults over the age of 50. This examiner explained the usual trajectory of this skin disorder as sometimes hereditary or as due to the pigment of the skin. This examiner explained that this skin disorder can affect any part of the body and become thicker and darker with time. In September 2020, another VA examination and opinion were obtained on the matter to rectify the Veteran's diagnosis with other treatment records in the file. During this examination, the examiner determined that the Veteran's skin diagnosis was actually lichen simplex chronicus, rather than dermatitis. But this examiner also noted this skin condition was then currently resolved. In April 2021, still another VA examination and opinion were obtained to determine if the Veteran's lichen simplex chronicus was related to his service. To assist in making this important determination, the examiner reviewed the record and concluded that it is less likely than not the Veteran's skin disorder was related to his service. This most recent examiner explained that there was no indication in the record of chloracne that would be presumptively related to herbicide exposure. This examiner agreed with the September 2020 VA examiner in finding that the correct diagnosis was lichen simplex, rather than dermatitis. This was supported by the treatment the Veteran had received for his skin disorder as documented in the treatment records. This examiner considered the Veteran's symptoms beginning in around 1980. Ultimately, however, this examiner, like those prior, concluded there was no evidence of a connection between the Veteran's post-service skin symptoms and his service. This examiner agreed that the medical record did not support a relationship between the claimed skin disorder and the Veteran's service, given the type or kind of skin disorder he had and the clinical history of onset. While the Veteran and, by extension, his widow are competent to report having experienced symptoms of itching in service and during the appeal period, or to have observed this, they are not competent to provide a diagnosis or ascribe symptoms experienced to a particular diagnosis including in terms of determining whether they were manifestations of jungle rot or a result or consequence of exposure to herbicides in service. This issue is medically complex, not merely simple, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). To that extent, the Veteran provided only conclusory statements in support of the claim that his current symptoms were related to his service. On the other hand, the May 2018, September 2019, September 2020, and April 2021 VA examiners opined that the Veteran's skin disability is not at least as likely as not related to an in-service injury, event, or disease. The examiners opinions are probative because they are based on an accurate medical history. When taken together, they provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Specifically, the VA examiners agreed that the Veteran's post-service skin disability did not present as related to the conditions of his service in Vietnam or as due to exposure to herbicides in service. Absent an indication from him that the symptoms had begun in service, or documentation that the symptoms began in service, the examiners could not relate the claimed disability to his service. The Board finds that the VA examiners' opinions are consistent with the record, as the Veteran reported to his VA physicians on multiple occasions that his symptoms had begun around 1980 or just before or even after. And, while he reported his belief that his skin disability seemed similar to the jungle rot he had experienced in service, again, his statements are outweighed by the competent medical opinions of record ultimately finding no relationship or correlation between his current skin disability and service, to include previous tinea pedis (Athlete's foot). See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). For these reasons and bases, the preponderance of the evidence is against this claim, so it must be denied. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals R. Erdheim, Attorney for the Board Department of Veterans Affairs The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.